Airway strategy and ventilation rates in the pragmatic airway resuscitation trial

Henry E. Wang, Xabier Jaureguibeitia, Elisabete Aramendi, Graham Nichol, Tom Aufderheide, Mohamud R. Daya, Matthew Hansen, Michelle Nassal, Ashish R. Panchal, Dhimitri A. Nikolla, Erik Alonso, Jestin Carlson, Robert H. Schmicker, Shannon W. Stephens, Unai Irusta, Ahamed Idris

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We sought to describe ventilation rates during out-of-hospital cardiac arrest (OHCA) resuscitation and their associations with airway management strategy and outcomes. Methods: We analyzed continuous end-tidal carbon dioxide capnography data from adult OHCA enrolled in the Pragmatic Airway Resuscitation Trial (PART). Using automated signal processing techniques, we determined continuous ventilation rates for consecutive 10-second epochs after airway insertion. We defined hypoventilation as a ventilation rate < 6 breaths/min. We defined hyperventilation as a ventilation rate > 12 breaths/min. We compared differences in total and percentage post-airway hyper- and hypoventilation between airway interventions (laryngeal tube (LT) vs. endotracheal intubation (ETI)). We also determined associations between hypo-/hyperventilation and OHCA outcomes (ROSC, 72-hour survival, hospital survival, hospital survival with favorable neurologic status). Results: Adequate post-airway capnography were available for 1,010 (LT n = 714, ETI n = 296) of 3,004 patients. Median ventilation rates were: LT 8.0 (IQR 6.5–9.6) breaths/min, ETI 7.9 (6.5–9.7) breaths/min. Total duration and percentage of post-airway time with hypoventilation were similar between LT and ETI: median 1.8 vs. 1.7 minutes, p = 0.94; median 10.5% vs. 11.5%, p = 0.60. Total duration and percentage of post-airway time with hyperventilation were similar between LT and ETI: median 0.4 vs. 0.4 minutes, p = 0.91; median 2.1% vs. 1.9%, p = 0.99. Hypo- and hyperventilation exhibited limited associations with OHCA outcomes. Conclusion: In the PART Trial, EMS personnel delivered post-airway ventilations at rates satisfying international guidelines, with only limited hypo- or hyperventilation. Hypo- and hyperventilation durations did not differ between airway management strategy and exhibited uncertain associations with OCHA outcomes.

Original languageEnglish (US)
Pages (from-to)80-87
Number of pages8
JournalResuscitation
Volume176
DOIs
StatePublished - Jul 2022

Keywords

  • Airway management
  • Cardiopulmonary arrest
  • Emergency medical services
  • Intubation
  • Ventilation

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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